Tobacco Smoking in HIV-Infected versus General Population in France: Heterogeneity across the Various Groups of People Living with HIV

Abstract

BackgroundAlthough the various groups of people living with HIV (PLWHIV) considerably differ regarding socioeconomic and behavioral characteristics, their specificities regarding tobacco smoking have been poorly investigated. We aimed to assess patterns of tobacco consumption across the various groups of PLWHIV and to compare them to the general population, accounting for the specific socioeconomic profile of PLWHIV.MethodsWe used data of the ANRS-Vespa2 study, a national representative survey on PLWHIV conducted in France in 2011. Prevalence of past and current tobacco consumption, heavy smoking and strong nicotine dependence were assessed among the various groups of PLWHIV as defined by transmission category, gender and geographic origin, and compared to the French general population using direct standardization and multivariate Poisson regression models, accounting for gender, age, education and geographic origin.ResultsAmong the 3,019 participants aged 18–85 years (median time since HIV diagnosis: 12 years), 37.5% were current smokers and 22.1% were past smokers, with marked differences across the various groups of PLWHIV. Compared to the general population, the prevalence of regular smoking was increased among HIV-infected men who have sex with men (MSM) (adjusted prevalence rate ratio (aPRR): 1.19, 95% confidence interval (95% CI): 1.07–1.32), French-native women (aPRR: 1.32, 95% CI: 1.10–1.57), and heterosexual French-native men (although not significantly, aPRR: 1.19, 95% CI: 0.98–1.45). Additionally, HIV-infected MSM were significantly less likely to be ex-smokers (aPRR: 0.73, 95% CI: 0.64–0.82) than the general population and similar trends were observed among heterosexual French-native men (aPRR: 0.89, 95% CI: 0.78–1.02) and women (aPRR: 0.84, 95% CI: 0.70–1.01). HIV-infected sub-Saharan African migrants were less likely to be regular smokers than the general population.ConclusionsSmoking constitutes a major concern in various groups of PLWHIV in France including MSM and heterosexual French-natives, probably resulting from PLWHIV being less likely to quit smoking than their counterparts in the general population.

Sex Differences in Tobacco Use Among Persons Living With HIV/AIDS: A Systematic Review and Meta-Analysis

“…Two studies used the Fagerström Test for Nicotine Dependence 38 to examine moderate or strong dependence on nicotine in PLWH by gender 39,40 , a third study used the Modified Fagerström Tolerance Questionnaire 41 , and a fourth study defined dependence by either the time to first cigarette in the morning (<30 minutes) or CPD (>20) 42 . While there was no significant gender difference in the report of moderate/strong nicotine dependence in 509 adults in France (men 60.9%; women 58.2%; OR=1.12, 95% CI=0.61-2.06) 39 , a lower percentage of women (47.8%) than men (60.0%) reported moderate/strong nicotine dependence in a sample of 1094 U.S. adults (OR=1.5, 95% CI=1.0-2.2, p<0.05) 40 .…”

Increase in Unemployment over the 2000’s: Comparison between People Living with HIV and the French General Population

“…The ANRS-Vespa study [VIH, enquête sur les personnes atteintes—HIV, survey on people living with HIV] was a repeated cross-sectional survey conducted among two large, nationally representative samples of HIV-infected people followed at hospitals in France in 2003 and 2011, with the primary aim of assessing the various dimensions of the socioeconomic conditions and health of PlwHIV in France. Full details regarding the study design are available elsewhere[22,23]. …”

“…The ANRS-Vespa2 survey was conducted between April 2011 and January 2012 among 3022 PlwHIV recruited in 73 hospital departments in mainland France, using a similar design. In both surveys and each participating hospital department, a sample of eligible patients (5080 in 2003 and 5617 in 2011), randomly selected according to the order of their appointment, were invited to participate by their physician[22]. In the ANRS-Vespa1 and ANRS-Vespa2 studies, after having being informed of the survey by their physician, eligible patients who agreed to participate signed a letter of informed consent in duplicate.…”

“…In both surveys data were weighted to account for the sampling design and participation bias. Details regarding the weighting procedure are provided elsewhere [22]. Both surveys received approval from the French Advisory Committee on Information Processing in Material Research in the Field of Health (CCTIRS) and met the ethical requirements of the French National Commission for Computing and Liberties (CNIL).…”

Cancer screening in women living with HIV infection

“…Several studies have showed that PLWHA lose more life years to smoking than to HIV. 22,23 We must not view lung cancer screening as an alternative to smoke cessation. 24 Although beyond the scope of this review, the British HIV Association has recently published a comprehensive review of how best to address smoking cessation efforts in PLWHA.…”